Creating Roadmaps for Surgeons
Using the Mac for Better Surgical Navigation
“It’s hard to detect the location of very small cancers laparoscopically,” says Sugimoto. “But when we project on the patient’s body, we can see the exact location of even a very small cancer using multi-detector CT reconstruction. That helps us to pinpoint the insertion of the ports and accomplish three things: avoiding injury to organs when we make the insertions; strategically placing the ports for efficient navigation with the scope; and keeping the number of ports to a minimum. All this adds up to minimally invasive surgery.”
With the ports in place and the scope inserted near the cancer site, Sugimoto aims the remote at the Apple Cinema Display and, with a flick of the wrist, he rotates the image of a section of colon to study the lesions. After a 360-degree examination on OsiriX using the Mac Pro, he proceeds with the operation. For some procedures, Sugimoto connects the remote to the laparoscope, so that the image on the scope monitor and the 3D image on the Apple Cinema Display move in concert.
“It’s common for surgeons operating on these cancers to use aggressive open surgery, making a midline incision to open the stomach,” says Sugimoto. “But our technique gives patients a better chance for faster recovery.”
Visualization for Major Open Surgery
For major gastrointestinal surgeries, particularly in the team’s sub-specialty of hepatic/biliary/pancreatic (HBP) surgery, Sugimoto uses the Mac and OsiriX in a different way.
“When we perform aggressive surgeries such as those for pancreatic cancer, many organs, blood vessels, and lymph nodes need to be removed,” says Sugimoto. “If the cancer has invaded the vascular system, we have to determine its surgical margin to complete the resection and vascular reconstruction. Pre-operative volume visualization helps us to be more efficient in the operating room.”
Sugimoto uses real-time 3D volume rendering with OsiriX as a reference during open surgery, manipulating images on the Apple Cinema Display to get a more explicit view of surgical targets.
“The 3D visualization shows us relationships between the cancer and the arterial vessels and other surrounding organs,” says Sugimoto. “It also allows us to see the extent of the spread of cancer. When a patient has upper biliary (bile duct) cancer, we have to cut the liver. If the patient has lower bile duct cancer we have to remove the pancreatic head and duodenum. The HBP system is very complex; that’s why 3D visualization in the OR is so crucial. When doing a midline open surgery, the surgeon can only see the organs from the top. With OsiriX on the Mac, surgeons can rotate and see the surrounding organs in 3D to guide them during surgery.”
An Easily Adoptable Technology
Sugimoto and his team do about 50 major surgeries a month using his 3D visualization techniques. Of these, Sugimoto does about 20 himself. Major surgeries, such as pancreatic cancer surgery involving the vascular system, may take up to six hours; minor surgeries – laparoscopic cholecystectomies – take about an hour. The surgery group uses a variety of Macs to run OsiriX for processing DICOM images and planning surgeries. They record videos of all laparoscopic surgeries, and of some open surgeries, for educational purposes. Sugimoto uses iMovie 08 and Final Cut Express, both of which he finds simple and easy to use, to edit movies himself.
Sugimoto is modest about his innovations with the Mac.
“Many surgeons react with surprise when they first see these techniques demonstrated. But surgeons and physicians familiar with OsiriX see them as practical and easy to implement. They know it’s easy to work with OsiriX volumetric images, and that OsiriX handles segmentation and 3D rendering of DICOM images with ease. And they can see the value that visualization can have in the OR.”
Sugimoto has given presentations at many Japanese and international institutions explaining his techniques. Each presentation is usually followed by requests to give it elsewhere, including the United States. In Japan a number of surgeons and physicians have seen the presentation, purchased Macs, downloaded OsiriX, and started using his visualization methods in surgery and daily clinics.
“These techniques are very easy for surgeons and physicians to adopt,” says Sugimoto. “After all, I did it.”
The bottom line here is that Sugimoto’s innovative use of OsiriX and the Mac has improved the level of care for his team’s surgical patients. Using visualization to plan surgeries, to navigate to surgical sites, and identify even minute lesions – as well as implementing minimally invasive techniques where they are not commonly used – helps assure that patients will experience the best possible outcomes.
